> Edit: and I have an anecdote about this too. Last year I had an episode of AFib. I've been taking medication since then. So after almost 1 year taking a certain medication, my insurance rejected it, saying they wouldn't pay for it and that I had to switch to something else. Now, why is it OK for an insurance company to dictate what I can or cannot take, if my doctor prescribed me something? How on earth is it OK for insurance to dictate what treatments I can or cannot have? I feel like a piece of meat when I go to a clinic and they need to call my insurance to see if it is OK to give me a certain treatment. This is nuts.

Dictating what treatments you can and cannot have is how health systems all over the world control costs. Many systems do this much more aggressively than in the U.S. The U.K. NHS, for example, will only spend about 20-30,000 pounds per "quality-adjusted life year," or about double that for end-of-life drugs. In the U.S., it is routine to spend hundreds of thousands of dollars just to get a couple of extra years. (The historic practice in the U.S. was to have lifetime limits--typically in the several million dollar range, but even those are illegal under the ACA.)

My point was to compare it to pre ACA. Our system improved significantly when the ACA was passed.

Now, if you're sharing the cost of a treatment with someone, they're always going to have a say in the treatment you get, unfortunately.

That's true under any system.

Your doctor may have been incentivized by the pharma company to prescribe their more expensive product.